Im Lily, Allingham R Rand, Singh Inder, Stinnett Sandra, Fekrat Sharon
Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD, USA.
J Glaucoma. 2008 Mar;17(2):128-32. doi: 10.1097/IJG.0b013e31814b9948.
To prospectively monitor intraocular pressure (IOP) and gonioscopy changes within the first month after a single 4-mg intravitreal injection of triamcinolone acetonide (IVK) (Kenalog, Briston-Meyers Squibb, New York).
Prospective comparative interventional case series.
A consecutive series of 28 eyes of 14 patients with no prior intravitreal injections or history of glaucoma were prospectively enrolled. After baseline evaluation in both eyes, including IOP, gonioscopy, and optic nerve evaluation, a single 4-mg IVK was given in a standard sterile fashion in the eye to be treated. Eyes received IVK for macular edema associated with retinal vein occlusions and in conjunction with photodynamic therapy for choroidal neovascularization secondary to age-related macular degeneration, ocular histoplasmosis, and high myopia. The fellow eye served as the control. After the injection, IOP and gonioscopy were repeated at 1, 2, and 4-week intervals in both eyes.
Of the 14 patients, the 5 women and 9 men had a mean age of 67.6 years. Mean baseline IOP of the treated and fellow control eyes were similar at 15.9 versus 16.6 mm Hg, respectively. The control eyes maintained a small IOP range (15.6 to 16.6 mm Hg) during the 1-month follow-up period. In the treated eyes, the mean maximum IOP was 54% above baseline during follow-up, compared with 11% for control eyes. Six of 14 (43%) treated eyes had IOP elevation to 24 mm Hg or higher with mean change of 8.6 mm Hg and a mean maximum IOP of 32.1 mm Hg. There was no correlation between IOP rise and age, sex, diagnosis, or optic nerve appearance. However, during the course of the study, 4 of 6 (67%) of the treated eyes that required topical drops for the IOP elevation had documented abnormal inferior angle changes characterized by pigmented particulate matter in the inferior angle not present at the baseline exam. The most frequent time point for an IOP elevation that required treatment was at 2-week postinjection. No eyes required surgical management of IOP during the course of this 4-week study.
We observed a significant IOP rise in eyes after a single intravitreal injection of 4 mg of triamcinolone within 1 month of injection. In this study, the most frequent time point that required IOP treatment was at 2-week postinjection, suggesting that early and frequent monitoring of IOP should be considered. Two-thirds of eyes that required medical control of IOP developed gonioscopy changes, characterized by particulate matter in the inferior angle, not present at baseline. Eyes that developed gonioscopic changes were 5 times more likely to be treated for IOP elevation than those without gonioscopic findings.
前瞻性监测单次玻璃体内注射4毫克曲安奈德（IVK）（康宁克通，百时美施贵宝公司，纽约）后第一个月内的眼压（IOP）和前房角镜检查变化。
前瞻性比较干预性病例系列。
前瞻性纳入14例既往未行玻璃体内注射或无青光眼病史患者的28只眼。对双眼进行包括眼压、前房角镜检查和视神经评估在内的基线评估后，以标准无菌方式在待治疗眼内注射单次4毫克IVK。这些眼睛接受IVK治疗与视网膜静脉阻塞相关的黄斑水肿，并与光动力疗法联合用于治疗年龄相关性黄斑变性、眼组织胞浆菌病和高度近视继发的脉络膜新生血管。对侧眼作为对照。注射后，双眼分别在1、2和4周时重复测量眼压和进行前房角镜检查。
14例患者中，5名女性和9名男性，平均年龄67.6岁。治疗眼和对侧对照眼的平均基线眼压相似，分别为15.9毫米汞柱和16.6毫米汞柱。对照眼在1个月的随访期内眼压范围较小（15.6至16.6毫米汞柱）。在治疗眼中，随访期间平均最大眼压比基线升高54%，而对照眼为11%。14只治疗眼中有6只（43%）眼压升高至24毫米汞柱或更高，平均变化8.6毫米汞柱，平均最大眼压32.1毫米汞柱。眼压升高与年龄、性别、诊断或视神经外观之间无相关性。然而，在研究过程中，6只因眼压升高需要局部滴眼的治疗眼中有4只（67%）记录到前房角异常变化，其特征为前房角有色素颗粒物质，基线检查时不存在。需要治疗的眼压升高最常见的时间点是注射后2周。在这项为期4周的研究过程中，没有眼睛需要进行眼压的手术治疗。
我们观察到单次玻璃体内注射4毫克曲安奈德后1个月内眼压显著升高。在本研究中，需要治疗眼压最常见的时间点是注射后2周，这表明应考虑早期和频繁监测眼压。三分之二需要药物控制眼压的眼睛出现了前房角镜检查变化，其特征为基线时不存在的前房角颗粒物质。出现前房角镜检查变化的眼睛因眼压升高接受治疗的可能性是未出现前房角镜检查结果眼睛的5倍。
